title: Could FEV₁ decline have a role in daily clinical practice for asthma monitoring?
abstract: OBJECTIVE
  The aim of this review was to understand whether FEV1 decline measured during the follow-up of asthmatic subjects (FEV1 variation between two different measurements at a distance of at least 5 years) may have a role in their management.
  
  
  METHODS
  Articles, commentaries and reviews relating to the topic were searched in PubMed.
  
  
  RESULTS
  Patients with an accelerated FEV1 decline (>30 ml/year) may be either steroid-resistant/difficult-to-treat asthmatics or not adequately treated because they are either under-perceivers or poorly adherent to their therapy. Sometimes they may be unable to use devices correctly. Untreated rhinitis and incorrect lifestyle (obesity status, a high-fat diet and lack of exercise) must be considered when facing a pulmonary function decline. Identifying asthmatics with an accelerated FEV1 decline, even with well controlled symptoms, may allow us to make possible treatment adjustments or to remove potentially harmful environmental exposure and suggest a correct lifestyle. Depending on FEV1 decline severity, we may detect different asthma phenotypes. One type is characterized by no/low lung function reduction. Among moderate/severe 'declining' subjects, there may be a group that might be responsive to treatment and a second one with a quicker loss in lung function that may be unresponsive to therapy.
  
  
  CONCLUSIONS
  FEV1 decline calculation should be assessed early in clinical practice over the course of time in order to make all possible variations in treatment, environmental exposure and lifestyle more efficacious overall for declining subjects responsive to anti-inflammatory therapy. Further studies are necessary to validate this approach to asthma.
authors.affiliation: Unit of Pneumology, Misericordia Hospital , Grosseto , Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Sposato
mesh_terms: D000403:Airway Resistance; D001249:Asthma / Q000503:physiopathology* / Q000628:therapy; D004781:Environmental Exposure; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D012307:Risk Factors; D015599:Trauma Severity Indices